A top psychoanalyst uncovers what happens to Covid-19 patients on respirators, like Laurie Wiseman, and why the effects linger.

By Caroline Garland.

Laurie Wiseman had some extraordinary visions. They are visions because they are part-hallucination (a disturbance of perception), part-delusion (a disturbance of belief) and part-dream. The kind of dream in which we try hard to make sense of life, out of the residue of the day and out of ‘the devices and desires of our own hearts.’

He will never forget them: they are now a part of his waking life. Once again, awake and fully conscious, he can tell the difference between illusions and reality.

The medication that put him into a semi-coma certainly played its part in
creating these mental states, but their content has more to do with what was already important in his mind. His wife and family; wanting to be alive; his religion; the food he could not have; the famous sportsman he would like to meet. Some of these images have a self-comforting quality, but some of them are terrifying. The ghoulish figure of Death presenting as a seedy fat newshound was especially vivid.

Being a patient in an ICU is almost always a traumatic experience. I do not say that lightly: a trauma is an event that changes your life, changes the way your mind works. In this case there were two levels of trauma: the physical – the intubation, the pain, the hunger, the exhaustion; and the emotional, the constant dread. For many COVID patients, the fear is of the approach of a particularly horrible death. Freud pointed out that annihilation, the end of the self, is mankind’s greatest fear – not the only one, but certainly the most overwhelming. Recovery from a traumatic event takes a long time, and some serious internal work.

One of the complicating factors in recovery can be (though not always) the
presence of guilt: I am alive, but so many others died. This kind of ‘survivor guilt’ is very common following a major trauma in which others died. It can mean the survivor – and Laurie is a survivor – must keep his fierce pleasure in once more having his life, perhaps muted; perhaps for some, even under wraps.

Laurie’s case has had a happy ending; for others it may be more difficult. If eventually survivors find themselves unable to take up their lives again in a whole-hearted way, then it can be a help to talk this through with a trained therapist. In London, the Tavistock Clinic (where I worked for many years) offers this kind of help and all GPs are always in touch with counselling services. And don’t leave it too long.

If you are feeling continually low, with no pleasure to be found in the life the marvellous NHS has given you back again, then go and talk to someone about it.

Psychoanalyst Caroline Garland was the Founder of the Unit for the Study of Trauma and its Aftermath at the Tavistock Clinic in London. Her seminal book is Understanding Trauma, latest edition 2007.